Background

Throughout history, many cultures have used imagery for therapeutic purposes, including the Navajo, ancient Egyptians, Greeks, and Chinese. Religions such as Hinduism and Judaism have also practiced imagery. In modern times, the term "guided imagery" may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery.

Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Experienced guided imagery practitioners may use an interactive, objective guiding style to encourage patients to find solutions to problems by exploring their existing inner resources. Biofeedback is sometimes used with imagery to enhance meditative relaxation. Interactive guided imagery groups, classes, workshops, and seminars are available, as well as books and audiotapes.

Throughout history, many cultures have used imagery for therapeutic purposes, including the Navajo, ancient Egyptians, Greeks, and Chinese. Religions such as Hinduism and Judaism have also practiced imagery. In modern times, the term "guided imagery" may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery.

Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Experienced guided imagery practitioners may use an interactive, objective guiding style to encourage patients to find solutions to problems by exploring their existing inner resources. Biofeedback is sometimes used with imagery to enhance meditative relaxation. Interactive guided imagery groups, classes, workshops, and seminars are available, as well as books and audiotapes.

Theory

It is theorized that the process of visualizing images can evoke sensory memory, strong emotions, or fantasy that in turn may affect the mind and body in beneficial ways. Imagery techniques have been proposed to cause a number of changes in body functions, including alterations in breathing, heart rate, blood pressure, metabolism, and the gastrointestinal system, immune system, and endocrine system. Practitioners often aim to use a variety of senses, including touch, smell, sight, and sound, to achieve a tranquil state by decreasing negative physical symptoms.

Evidence

DISCLAIMER:
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Headache:
Initial research suggests that guided imagery may provide added benefits when used at the same time as standard medical care for migraine or tension headache. Further study is needed before a strong conclusion can be drawn.
Grade: B

Pain:
Early research suggests that guided imagery may help reduce cancer pain, intravenous needle pain, nerve pain from spinal cord damage, or lower postoperative pain ratings in children. Further research is needed to confirm these results.
Grade: B

Anxiety and wound healing after surgery:
Initial evidence suggests that guided imagery relaxation audiotapes may reduce anxiety after surgeries, and may improve healing. More study is needed before a strong recommendation can be made.
Grade: C

Anxiety/depression in multiple sclerosis:
Early research suggests that the use of imagery may reduce anxiety but not depression or physical symptoms in patients with multiple sclerosis. Additional research would be helpful in this area.
Grade: C

Bulimia nervosa:
Evidence from early research suggests that guided imagery may be an effective treatment for bulimia nervosa, at least in the short-term. Further study is needed before firm conclusions can be drawn.
Grade: C

General health maintenance:
Although guided-imagery meditation is popularly used with yoga for general health maintenance, there is not enough scientific evidence in this area.
Grade: C

Insomnia:
Early research supports the value of combined pharmacotherapy and relaxation training in the treatment of insomnia. Further research is necessary in order to make a firm recommendation.
Grade: C

Juvenile rheumatoid arthritis:
Cognitive-behavioral interventions for pain may be an effective adjunct to standard pharmacologic interventions for pain in patients with juvenile rheumatoid arthritis. Further research is needed to confirm these results.
Grade: C

Memory:
Early research suggests that guided imagery of short duration may improve working memory performance. Further research is needed before a firm conclusion can be drawn.
Grade: C

Osteoarthritis:
Early research suggests a reduction in pain and mobility difficulties in patients with osteoarthritis. Further research is needed before a firm conclusion can be drawn.
Grade: C

Quality of life in cancer patients:
Preliminary studies suggest that quality of life and sense of comfort may be improved by guided imagery techniques such as relaxation/imagery training tapes. Further research is needed before a firm conclusion can be drawn.
Grade: C

Quality of life in HIV patients:
Initial evidence suggests that occasional use of guided imagery techniques may improve quality of life in people with HIV. Additional research is needed in this area before a recommendation can be made.
Grade: C

Relaxation in chronic obstructive pulmonary disease (COPD):
A small study reports increased relaxation outcomes in people with chronic obstructive pulmonary disease (emphysema or chronic bronchitis) who use guided imagery techniques. Additional research is needed to confirm these results.
Grade: C

Smoking cessation:
Based on early study, guided imagery in addition to education and counseling sessions may be helpful for long-term smoking cessation and abstinence in adult smokers. Further study is needed to confirm these results.
Grade: C

Upper respiratory tract infections:
Preliminary research in children suggests that stress management and relaxation with guided imagery may reduce the duration of symptoms due to upper respiratory tract infections. Additional research is needed to confirm these results.
Grade: C

Safety

DISCLAIMER:
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Serious adverse effects have not been reported in the available scientific literature. Theoretically, intense inward focusing may cause pre-existing psychological problems or personality disorders to surface. Guided imagery should not be relied upon as a sole therapy for potentially serious medical problems. Guided imagery is usually used as a supplemental technique to other treatments, not as a replacement.

Guided imagery techniques should not be practiced while driving or during other activity requiring strict attention. Guided imagery may trigger physical symptoms that can be brought about by stress, anxiety, or emotional upset. If practicing guided imagery produces anxiety, a qualified healthcare professional should be consulted. Similarly, people with a history of trauma or abuse should speak with a healthcare professional before using this technique.

Bibliography

DISCLAIMER:
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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